OMM COMAT EXAM QUESTIONS AND
ANSWERS
A 22-year-old female presents with right forearm paresthesia. Structural examination
reveals restricted transverse carpal ligament and palmar fasciae. Which of the following
represents the most appropriate initial position when performing direct myofascial
release? - Correct Answers -E. Forearm supinated with the wrist neutral or extended
A 44-year-old male presents with debilitating left lower back pain and dark, tinted urine
of one weeks' duration. History reveals the back pain is sharp at a 8 out of 10 on the
pain scale and localized to the lower left paraspinal region. The urine is described as
being "cola or tea colored." An abdominal CT scan without contrast is obtained
revealing a 4 mm stone within the proximal left ureter. Which of the following spinal
segments will most likely facilitate tissue texture changes in this patient? - Correct
Answers -C. T10-T11
A 49-year-old male presents with low back pain. History reveals an acute onset of
sharp, burning pain radiating down the leg that started while he working on his car in the
garage. An MRI of the lumbar spine is obtained revealing a herniated disc between the
L3 and L4 vertebrae. The most likely additional finding upon physical examination is -
Correct Answers -B. Absent patellar reflex
A 46-year-old male presents to the office with left-sided neck pain that began after he
drove home from visiting his parents in another state. His pain is non-radiating, and he
denies numbness and tingling of the upper extremities. His pain is worse when he turns
his head to the right, and he rates it as a 7/10. On examination, he has limited passive
rotation to the left and sidebending to the right. When the neck is flexed to 45 degrees,
there is rotational restriction to the left. What is the initial starting position of the neck for
muscle energy treatment? - Correct Answers -A. Left rotation
A 24-year-old female presents with low back pain of three months' duration. History
reveals she fractured her femoral growth plate as a child and subsequently has an
anatomically short right leg. Which of the following additional findings will most likely be
found upon structural examination? - Correct Answers -A. Cephalad sacral sulcus on
the left
A 39-year-old male presents to the office with the complaint of mid-back pain.
Osteopathic structural examination reveals the left transverse process immediately
,lateral to the T8 spinous process is more difficult to push anteriorly than the right when
performing intersegmental motion testing. This is more apparent when you induce
flexion but becomes more even when you induce extension. The most likely diagnosis is
- Correct Answers -D. T9 extended, rotated left, sidebend left
A 19-year-old football player presents after twisting his right knee during a game.
Physical examination reveals joint line tenderness and mild swelling in the area of
injury. A clicking and popping sound is appreciated during passive flexion and extension
of the right knee. The initial modality most appropriate for confirming the diagnosis is -
Correct Answers -D. MRI
A 22-year-old female presents with anxiety and obsessive-compulsive disorder.
Structural examination with the vault hold reveals the sphenoid and occiput to be in
extension. Under normal craniosacral mechanics, you suspect the sacral base to be -
Correct Answers -A. Anterior and inferior
A 21-year-old female who is 1 week post-partum presents with pelvic pain. History
reveals she had an unremarkable vaginal delivery without complications. Structural
examination reveals multiple pelvic tender points with an anterior lumbar tender point
corresponding to L4 on the right. Where and how is this tender point located? - Correct
Answers -A. inferior AIIS pressing cephalad
A 29-year-old male presents to the doctor's office with an occipital headache after he
sustained a rear-end collision in his car. His headache is intermittent, non-radiating,
non-pulsatile, and without photophobia. On palpation of his occipito-atlantal joint, there
is restriction in translation to the left, which improves with upper cervical flexion. Which
of the following is the correct starting position to begin treatment with muscle energy? -
Correct Answers -B. Cervical extension with the occiput sidebent right, rotated left
A 16-year-old female presents to the office after being hit on the left side of the head
with a softball 1 hour ago. The injury occurred during practice while she was throwing
with a teammate; someone across the field called her name, and she turned her head
and was hit with the ball while not paying attention. She did not lose consciousness.
She localizes the pain to the left central portion of her head and slightly posterior to her
left ear. She describes the pain as throbbing and rates it as a 6/10. She took an
ibuprofen on the field which has helped with some of the pain. She also complains of
point tenderness and mild swelling but denies vision changes, dizziness, nausea,
vomiting, or gait abnormalities. On physical exam, CN2-12 are intact without focal
neurologic deficits. There are no palpable cranial fractures, but the tissues around the
left central side of her head are red and boggy. On osteopathic exam, th - Correct
Answers -C. Left sidebending rotation
A 23-year-old G1P0 obese female is in active labor at 40 weeks' gestation. After many
hours of difficult labor she gives birth to a 9 pound baby boy. Which of the following
structural abnormalities of the mother is likely to be seen in the post-partum period? -
Correct Answers -A. Bilateral sacral flexion
,A 35-year-old female presents with abdominal bloating and cramping in the left lower
quadrant, bloody and diarrhea more than ten times daily, a 15-pound weight loss, and
hematochezia. Her symptoms began one month ago, with no prior history. Vital signs
are normal. Physical examination reveals left lower quadrant abdominal tenderness
without rebound, no masses, and normal bowel sounds. Stool is positive for occult
blood. The most likely location of a corresponding parasympathetic viscerosomatic
reflex would be: - Correct Answers -E. S2-S4
A 30-year-old female transcriptionist presents with neck pain of 7 days' duration.
Osteopathic structural exam is significant for a tender C3 that is extended, rotated left,
sidebent left. What is the most appropriate initial position for treatment with Still's
technique of this lesion? - Correct Answers -A. Extension, rotation to the left,
sidebending to the left
A 55-year-old male presents to the office with the complaint of right shoulder pain.
History reveals the pain has been worsening over the last few weeks and is associated
with any motion of the shoulder. Physical examination reveals a negative drop arm test
and apprehension test, however, active and passive range of motion is severely
restricted in each plane of motion of the right shoulder. Deep tendon reflexes are 2+ at
biceps, triceps, and brachioradialis bilaterally. The correct sequence of motion using the
most appropriate technique is - Correct Answers -C. Extension, flexion, circumduction
with compression, circumduction with traction, abduction, internal rotation, pump
A 54-year-old male presents to his family physician's office with 2 weeks of slowly
worsening right shoulder pain. The pain is described as sharp, 6/10, and worse when he
tries to lift his arm away from his side. He does not recall any specific injury, but he
plays baseball for a recreational league after work. On palpation, there is a tender point
in the right supraspinatus fossa. Pain is also elicited when the physician moves the
patient's arm to 90° of abduction, 30° of flexion, and internal rotation until the thumb
points down, and pushes down on the arm against resistance. After discussing
treatment options, the patient consents to osteopathic treatment, and the physician
decides to use counterstrain to treat the affected tender point. Which of the following is
the correct initial positioning to treat the patient with counterstrain? - Correct Answers -
B. Patient supine, arm flexed and abducted with humerus externally rotated
A 54-year-old male presents to the office with the complaint of right hip pain and trouble
walking. History reveals the patient is a construction worker and the pain began after
falling from a ladder. Structural examination reveals the following:
Seated flexion test: positive on the leftSacral base: anterior on the leftInferolateral
angle: posterior on the rightLumbosacral spring test: negative
Based on the physical examination finding the most likely intersegmental somatic
dysfunction at L5 is - Correct Answers -D. Neutral, rotated left, sidebent right
A 32-year-old male presents to the physician's office after a brick fell on his head while
working at a construction site. He states that he did not lose consciousness but has
, some mild swelling and 5/10 nonradiating pain. He denies vomiting, blurry vision,
dizziness, and speech or gait changes. Physical examination reveals mild soft tissue
swelling along the apex of the head without ecchymosis or hematoma. Cranial nerves II-
XII are intact without focal neurologic deficits. On osteopathic examination, the
physician palpates the cranial rhythm impulse and finds that it is 7 cycles/min. After
explaining the risks and benefits of osteopathic manipulation and cranial treatment
techniques, the physician places the patient's head in the vault hold. While appreciating
the cranial rhythm, the physician's index fingers move superior while the little fingers
move inferior. Which of the following is the axis/axes of motion for - Correct Answers -D.
2 parallel transverse axes
A 21-year-old female who is three weeks post-partum presents with pelvic and buttock
pain. History reveals she had an unremarkable vaginal delivery without complications.
Structural examination reveals tissue texture abnormalities and tender points along the
right iliacus muscle. Which of the following is the most appropriate patient position for
treating these tender points with strain-counterstrain? - Correct Answers -B. Patient
supine with bilateral flexion of the hips and knees with external rotation of the thighs
A 76-year-old female presents to your office stating that she is "walking funny." She first
noticed this abnormality eight months ago when her left hip began hurting. She had
been diagnosed with mild to moderate degenerative joint disease of her left hip.
Physical examination reveals her right hip to drop when standing on her left leg. This is
most likely due to weakened - Correct Answers -A. Hip abductor
A 52-year-old male presents to the emergency department with perineal pain of several
days duration. He has had intermittent fevers with chills, fatigue, and dysuria, but denies
dyspnea, gross hematuria, hematochezia, and melena. Vital signs reveal:
Temperature 39.5°C (103.0°F) Blood pressure 140/90 mmHg Heart rate 120/min
Urinalysis reveals 10 white blood cells per high-power field (WBC/HPF) (reference: < 5
WBC/HPF) and laboratory studies reveal a leukocyte count of 14.0 x 103/µL (reference
range: 4.8-10.8 x 103/µL). Physical examination reveals bowel sounds are present and
normoactive in all 4 quadrants. There is no abdominal tenderness or rebound
tenderness. Rectal examination reveals a boggy prostate that is tender to palpation.
Based on the most likely diagnosis, where would a corresponding Chapman's reflex
point be found? - Correct Answers -C. Posterior superior illiac spine
A 12-year-old female presents with right foot pain. Structural examination reveals
excessive right foot pronation while walking, an elongation of the second digit of the foot
compared to the first digit and callus formation on the plantar forefoot under the 2nd and
3rd metatarsal heads. A plain film radiograph reveals thickening of the second
metatarsal bone. The most likely diagnosis is - Correct Answers -E. Morton foot
A 35-year-old male presents with neck pain and stiffness. History reveals that he works
as a painter and spent two hours the other day in a position that had his neck "twisted in
ANSWERS
A 22-year-old female presents with right forearm paresthesia. Structural examination
reveals restricted transverse carpal ligament and palmar fasciae. Which of the following
represents the most appropriate initial position when performing direct myofascial
release? - Correct Answers -E. Forearm supinated with the wrist neutral or extended
A 44-year-old male presents with debilitating left lower back pain and dark, tinted urine
of one weeks' duration. History reveals the back pain is sharp at a 8 out of 10 on the
pain scale and localized to the lower left paraspinal region. The urine is described as
being "cola or tea colored." An abdominal CT scan without contrast is obtained
revealing a 4 mm stone within the proximal left ureter. Which of the following spinal
segments will most likely facilitate tissue texture changes in this patient? - Correct
Answers -C. T10-T11
A 49-year-old male presents with low back pain. History reveals an acute onset of
sharp, burning pain radiating down the leg that started while he working on his car in the
garage. An MRI of the lumbar spine is obtained revealing a herniated disc between the
L3 and L4 vertebrae. The most likely additional finding upon physical examination is -
Correct Answers -B. Absent patellar reflex
A 46-year-old male presents to the office with left-sided neck pain that began after he
drove home from visiting his parents in another state. His pain is non-radiating, and he
denies numbness and tingling of the upper extremities. His pain is worse when he turns
his head to the right, and he rates it as a 7/10. On examination, he has limited passive
rotation to the left and sidebending to the right. When the neck is flexed to 45 degrees,
there is rotational restriction to the left. What is the initial starting position of the neck for
muscle energy treatment? - Correct Answers -A. Left rotation
A 24-year-old female presents with low back pain of three months' duration. History
reveals she fractured her femoral growth plate as a child and subsequently has an
anatomically short right leg. Which of the following additional findings will most likely be
found upon structural examination? - Correct Answers -A. Cephalad sacral sulcus on
the left
A 39-year-old male presents to the office with the complaint of mid-back pain.
Osteopathic structural examination reveals the left transverse process immediately
,lateral to the T8 spinous process is more difficult to push anteriorly than the right when
performing intersegmental motion testing. This is more apparent when you induce
flexion but becomes more even when you induce extension. The most likely diagnosis is
- Correct Answers -D. T9 extended, rotated left, sidebend left
A 19-year-old football player presents after twisting his right knee during a game.
Physical examination reveals joint line tenderness and mild swelling in the area of
injury. A clicking and popping sound is appreciated during passive flexion and extension
of the right knee. The initial modality most appropriate for confirming the diagnosis is -
Correct Answers -D. MRI
A 22-year-old female presents with anxiety and obsessive-compulsive disorder.
Structural examination with the vault hold reveals the sphenoid and occiput to be in
extension. Under normal craniosacral mechanics, you suspect the sacral base to be -
Correct Answers -A. Anterior and inferior
A 21-year-old female who is 1 week post-partum presents with pelvic pain. History
reveals she had an unremarkable vaginal delivery without complications. Structural
examination reveals multiple pelvic tender points with an anterior lumbar tender point
corresponding to L4 on the right. Where and how is this tender point located? - Correct
Answers -A. inferior AIIS pressing cephalad
A 29-year-old male presents to the doctor's office with an occipital headache after he
sustained a rear-end collision in his car. His headache is intermittent, non-radiating,
non-pulsatile, and without photophobia. On palpation of his occipito-atlantal joint, there
is restriction in translation to the left, which improves with upper cervical flexion. Which
of the following is the correct starting position to begin treatment with muscle energy? -
Correct Answers -B. Cervical extension with the occiput sidebent right, rotated left
A 16-year-old female presents to the office after being hit on the left side of the head
with a softball 1 hour ago. The injury occurred during practice while she was throwing
with a teammate; someone across the field called her name, and she turned her head
and was hit with the ball while not paying attention. She did not lose consciousness.
She localizes the pain to the left central portion of her head and slightly posterior to her
left ear. She describes the pain as throbbing and rates it as a 6/10. She took an
ibuprofen on the field which has helped with some of the pain. She also complains of
point tenderness and mild swelling but denies vision changes, dizziness, nausea,
vomiting, or gait abnormalities. On physical exam, CN2-12 are intact without focal
neurologic deficits. There are no palpable cranial fractures, but the tissues around the
left central side of her head are red and boggy. On osteopathic exam, th - Correct
Answers -C. Left sidebending rotation
A 23-year-old G1P0 obese female is in active labor at 40 weeks' gestation. After many
hours of difficult labor she gives birth to a 9 pound baby boy. Which of the following
structural abnormalities of the mother is likely to be seen in the post-partum period? -
Correct Answers -A. Bilateral sacral flexion
,A 35-year-old female presents with abdominal bloating and cramping in the left lower
quadrant, bloody and diarrhea more than ten times daily, a 15-pound weight loss, and
hematochezia. Her symptoms began one month ago, with no prior history. Vital signs
are normal. Physical examination reveals left lower quadrant abdominal tenderness
without rebound, no masses, and normal bowel sounds. Stool is positive for occult
blood. The most likely location of a corresponding parasympathetic viscerosomatic
reflex would be: - Correct Answers -E. S2-S4
A 30-year-old female transcriptionist presents with neck pain of 7 days' duration.
Osteopathic structural exam is significant for a tender C3 that is extended, rotated left,
sidebent left. What is the most appropriate initial position for treatment with Still's
technique of this lesion? - Correct Answers -A. Extension, rotation to the left,
sidebending to the left
A 55-year-old male presents to the office with the complaint of right shoulder pain.
History reveals the pain has been worsening over the last few weeks and is associated
with any motion of the shoulder. Physical examination reveals a negative drop arm test
and apprehension test, however, active and passive range of motion is severely
restricted in each plane of motion of the right shoulder. Deep tendon reflexes are 2+ at
biceps, triceps, and brachioradialis bilaterally. The correct sequence of motion using the
most appropriate technique is - Correct Answers -C. Extension, flexion, circumduction
with compression, circumduction with traction, abduction, internal rotation, pump
A 54-year-old male presents to his family physician's office with 2 weeks of slowly
worsening right shoulder pain. The pain is described as sharp, 6/10, and worse when he
tries to lift his arm away from his side. He does not recall any specific injury, but he
plays baseball for a recreational league after work. On palpation, there is a tender point
in the right supraspinatus fossa. Pain is also elicited when the physician moves the
patient's arm to 90° of abduction, 30° of flexion, and internal rotation until the thumb
points down, and pushes down on the arm against resistance. After discussing
treatment options, the patient consents to osteopathic treatment, and the physician
decides to use counterstrain to treat the affected tender point. Which of the following is
the correct initial positioning to treat the patient with counterstrain? - Correct Answers -
B. Patient supine, arm flexed and abducted with humerus externally rotated
A 54-year-old male presents to the office with the complaint of right hip pain and trouble
walking. History reveals the patient is a construction worker and the pain began after
falling from a ladder. Structural examination reveals the following:
Seated flexion test: positive on the leftSacral base: anterior on the leftInferolateral
angle: posterior on the rightLumbosacral spring test: negative
Based on the physical examination finding the most likely intersegmental somatic
dysfunction at L5 is - Correct Answers -D. Neutral, rotated left, sidebent right
A 32-year-old male presents to the physician's office after a brick fell on his head while
working at a construction site. He states that he did not lose consciousness but has
, some mild swelling and 5/10 nonradiating pain. He denies vomiting, blurry vision,
dizziness, and speech or gait changes. Physical examination reveals mild soft tissue
swelling along the apex of the head without ecchymosis or hematoma. Cranial nerves II-
XII are intact without focal neurologic deficits. On osteopathic examination, the
physician palpates the cranial rhythm impulse and finds that it is 7 cycles/min. After
explaining the risks and benefits of osteopathic manipulation and cranial treatment
techniques, the physician places the patient's head in the vault hold. While appreciating
the cranial rhythm, the physician's index fingers move superior while the little fingers
move inferior. Which of the following is the axis/axes of motion for - Correct Answers -D.
2 parallel transverse axes
A 21-year-old female who is three weeks post-partum presents with pelvic and buttock
pain. History reveals she had an unremarkable vaginal delivery without complications.
Structural examination reveals tissue texture abnormalities and tender points along the
right iliacus muscle. Which of the following is the most appropriate patient position for
treating these tender points with strain-counterstrain? - Correct Answers -B. Patient
supine with bilateral flexion of the hips and knees with external rotation of the thighs
A 76-year-old female presents to your office stating that she is "walking funny." She first
noticed this abnormality eight months ago when her left hip began hurting. She had
been diagnosed with mild to moderate degenerative joint disease of her left hip.
Physical examination reveals her right hip to drop when standing on her left leg. This is
most likely due to weakened - Correct Answers -A. Hip abductor
A 52-year-old male presents to the emergency department with perineal pain of several
days duration. He has had intermittent fevers with chills, fatigue, and dysuria, but denies
dyspnea, gross hematuria, hematochezia, and melena. Vital signs reveal:
Temperature 39.5°C (103.0°F) Blood pressure 140/90 mmHg Heart rate 120/min
Urinalysis reveals 10 white blood cells per high-power field (WBC/HPF) (reference: < 5
WBC/HPF) and laboratory studies reveal a leukocyte count of 14.0 x 103/µL (reference
range: 4.8-10.8 x 103/µL). Physical examination reveals bowel sounds are present and
normoactive in all 4 quadrants. There is no abdominal tenderness or rebound
tenderness. Rectal examination reveals a boggy prostate that is tender to palpation.
Based on the most likely diagnosis, where would a corresponding Chapman's reflex
point be found? - Correct Answers -C. Posterior superior illiac spine
A 12-year-old female presents with right foot pain. Structural examination reveals
excessive right foot pronation while walking, an elongation of the second digit of the foot
compared to the first digit and callus formation on the plantar forefoot under the 2nd and
3rd metatarsal heads. A plain film radiograph reveals thickening of the second
metatarsal bone. The most likely diagnosis is - Correct Answers -E. Morton foot
A 35-year-old male presents with neck pain and stiffness. History reveals that he works
as a painter and spent two hours the other day in a position that had his neck "twisted in
